Anxiety in girls with autism

Explosive behaviour is seen as a typical autistic response to anxiety. But where boys tend to explode, girls are more likely to implode, internalising the anxiety. Sarah Wild offers tips on recognising and dealing with anxiety in autistic girls.

Girls and boys, men and women can have very different experiences of autism. Being a girl with autism can present its own unique challenges. Getting a diagnosis of autism can be difficult for girls and many girls are diagnosed late, or missed completely, because they mask their difficulties.

Some girls on the autistic spectrum are sociable and really challenge non-autistic people’s views about what autism is.

Some girls with autism are able to start conversations and can imitate social behaviour, so it looks as though they don’t have any difficulty in interacting with others. Other girls are passive, and this can be misinterpreted as shyness.

The result of not being diagnosed with autism early enough is that the girls suffer from feelings of anxiety, loneliness, isolation and depression.

What causes anxiety

Many girls and women on the autistic spectrum experience mental health difficulties. And many girls on the spectrum suffer from extremely high levels of anxiety every day. Their anxiety can be caused by a range of different factors, including:

Their sensory needs, and that the fact that sensory information can overwhelm them

Trying to imitate social behaviour all day, without really understanding what it means

Constantly vetting and editing personal responses to social situations without understanding what the right social response is

Change or the possibility of change.

Effects of anxiety

Pupils at Limpsfield Grange School have written a novel (with Vicky Martin) M is for Autism in which the character M describes anxiety as ‘an uncontrollable wild savage beast that prowls beside me taking me hostage at its will’.

The effects of anxiety can be debilitating – from being unable to leave your bedroom for weeks at a time, to being in a constantly anxious state. Anxiety can totally preoccupy thoughts and feelings. Living with such high and unrelenting levels of anxiety is exhausting and frustrating, and can have a significant impact on the young person’s mental health and on their family.

Recognising the signs of anxiety

Anxiety can sometimes be communicated through behaviour, which can include:

Avoiding tasks

Need to have very high levels of control of people, routines and environment

Obsessive, repetitive or intrusive thoughts

Meltdowns at the end of the day that last for hours.

Girls on the autistic spectrum may also have issues with eating or self-harming.

The majority of these behaviours are likely to be driven by anxiety, but can be misconstrued by other people as simply bad behaviour. Many girls on the spectrum are also at risk of developing depression as they realise that they are different from their peers, and they do not feel accepted by them.

Strategies for working with high levels of anxiety

Identifying situations that lead to anxiety.

Talking through any planned changes in advance.

Talking about how their body feels when they are anxious, as it is possible that they will not have connected the physical sensation (for example of feeling nauseous) with the emotion of anxiety.

Teaching calming strategies. This can be anything from concentrating on her breathing, to fiddling with a special bracelet, to using some calming hand lotion - whatever makes her feel better.

If something has gone wrong, talking about how it could be different next time, and making a plan for it to be different.

Asking 'what is the worst thing that can happen?' and then discussing her fears, putting them into perspective and context.

Try using cards with ‘big deal’ on one side and ‘not a big deal’ on the other. Ask the young person to categorise which the issue would be, and then talk through reasons why it might be less of a big deal than they think.

Celebrating difference. Everyone has things that they find difficult and things that they find easier. Build the young person’s confidence and self-esteem, so that they believe in themselves, and develop their resilience.

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